Thomson Reuters released the results of a survey of 100,000 families, which showed that almost a third of Americans report some difficulty paying for health care in the first wave of surveying in 2006 – a substantial increase from 2006.Further, in 2006 the main reason given for lack of access to care was lack of time, whereas in 2009 the reason given is lack of economic resources. (Double click on the graphics to enlarge them)

In yesterday’s New York Times magazine,David Leonhardt interviews Barack Obama on his view of the post-recession economy.Obama talks enthusiastically about the need for patient engagement, while he acknowledges that physicians drive many medical decisions.He endorses comparative effectiveness, in part to decrease the information asymmetry between patients and their physicians.He also tells the heart-wrenching story of his grandmother’s hip fracture just after her diagnosis of incurable cancer.

His quote directly:

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

There is a lot of nuance here.Obama talks about making decisions and not just doing everything all the time, but shows that he recognizes how difficult this will be.Decisions that are obvious on a policy basis are very hard to apply to ourselves and our loved ones.Of course, most Americans could not have paid for their grandmother’s hip replacements out of pocket.